Universal SARS-CoV-2 testing on admission to the labor and delivery unit: Low prevalence among asymptomatic obstetric patients

Goldfarb, Ilona T.; Diouf, Khady; Barth, William H.; Robinson, Julian N.; Katz, Daniel H.; Gregory, Katherine E.; Ciaranello, Andrea; Yawetz, Sigal; Shenoy, Erica S.; Klompas, Michael

doi:10.1017/ice.2020.255

Cited by 44 publications

(52 citation statements)

References 5 publications

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“…Of pregnant women receiving their care with Cook County Health and Hospital Systems, 11.1% tested positive for COVID-19, as did 5.1% of asymptomatic women. Although lower than the 13.7% rate reported in New York City [ 10 ], this rate is higher than reported in other urban areas [ 11 , 12 ]. All COVID-19 positive women in this study were either Latina or African American, which is consistent with the racial disparity reported nationally.…”

Section: Discussioncontrasting

confidence: 69%

Coronavirus Disease 2019 in Pregnancy: The Experience at an Urban Safety Net Hospital

et al. 2020

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Shortly after the identification of a novel coronavirus, the coronavirus disease 2019, or COVID-19, a global pandemic was declared. There have been conflicting data about the severity of COVID-19 disease course in pregnant women, with most US data suggesting an increase in severity and increased need for hospitalization and intubation in obstetric patients. In the general population, the disease is more common among racial and ethnic minority populations, and severity is increased with comorbid conditions and obesity. The purpose of this study is to characterize COVID-19 infection in pregnancy in a population of women getting prenatal care at an urban safety-net hospital. Beginning in April, 2020, all women were tested at admission for delivery, and additionally as an outpatient if presenting with COVID-19 symptoms. In three months, there were 208 discrete women tested and 23 (11.1%) who were positive for COVID-19. The incidence of COVID-19 was 5.1% in asymptomatic women being screened upon admission to the hospital. There was a high prevalence of obesity (68.2%) and other comorbid conditions (43.5%) in this population, and all patients were racial/ethnic minorities. Despite these risk factors, the patients uniformly had either mild or asymptomatic disease. No symptomatic patients required hospitalization for their infection. In this population of pregnant women at high risk for severe COVID-19 infection, only mild disease was observed.

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Section: Discussioncontrasting

confidence: 69%

Coronavirus Disease 2019 in Pregnancy: The Experience at an Urban Safety Net Hospital

et al. 2020

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“…From the 28 high or moderate quality studies included, 24 reported on the proportion of asymptomatic COVID-19 infection at initial testing and/or the proportion of COVID-19 infections remaining asymptomatic throughout follow-up [ 9 , 60 – 81 ] and five reported on transmission of COVID-19 from asymptomatic or pre-symptomatic index patients (one study reported both) [ 82 – 86 ].…”

Section: Resultsmentioning

confidence: 99%

Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

et al. 2020

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Background The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. Methods We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). Results Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. Conclusions Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.

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“…Studies have shown that rates of asymptomatic infection can approach 13.5% in areas with high rates of community transmission of COVID-19, 30,34,35 whereas other areas with lower rates of COVID-19 have seen asymptomatic rates below 4%. [36][37][38] Data from the CDC found that pregnant patients diagnosed with COVID-19 have similar rates of cough and shortness of breath compared to nonpregnant reproductive aged women; however, symptom status was missing in approximately 30% of pregnant patients compared to 10% of nonpregnant women. 33 Pregnant patients were found to less frequently report headaches, muscle aches, fever, chills, and diarrhea.…”

Section: Clinic Al Fe Ature Smentioning

confidence: 99%

COVID‐19‐related disease severity in pregnancy

Thompson

Nguyen

Noble

et al. 2020

American J Rep Immunol

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The pandemic caused by COVID-19 is affecting populations and healthcare systems worldwide. As we gain experience managing COVID-19, more data become available on disease severity, course, and treatment in patients infected with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, data in pregnancy remain limited. This narrative review of COVID-19 during pregnancy underscores key knowledge gaps in our understanding of the impact of this viral infection on reproductive health. Current data suggest that pregnant people have similar disease course and outcomes compared to nonpregnant people, with the majority experiencing mild disease; however, pregnant people may have increased risk of hospitalization and intensive care unit (ICU) admission. Among patients who develop severe and critical disease, major maternal morbidity and mortality have been described including cardiomyopathy, mechanical ventilation, extracorporeal membrane oxygenation, and death. Many questions remain regarding maternal severity of disease in COVID-19. Further research is needed to better understand disease course in pregnancy. Additionally, the inclusion of pregnant patients in therapeutic trials will provide vital data on treatment options for patients. As we continue to treat more patients affected by SARS-CoV-2, multidisciplinary care and continued research are both needed to achieve optimal outcomes for mother and fetus.

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Universal SARS-CoV-2 testing on admission to the labor and delivery unit: Low prevalence among asymptomatic obstetric patients

Cited by 44 publications

References 5 publications

Coronavirus Disease 2019 in Pregnancy: The Experience at an Urban Safety Net Hospital

Coronavirus Disease 2019 in Pregnancy: The Experience at an Urban Safety Net Hospital

Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

COVID‐19‐related disease severity in pregnancy

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